ArticleFrontiers in immunology2026
Clinical and PET/CT metabolic imaging characteristics across the evolving spectrum of visceral leishmaniasis and associated hemophagocytic lymphohistiocytosis.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To delineate the clinical and PET/CT metabolic imaging characteristics across the spectrum of visceral leishmaniasis(VL) and associated hemophagocytic lymphohistiocytosis (HLH), and to develop a simple risk score for identification of patients at risk of visceral leishmaniasis-associated hemophagocytic lymphohistiocytosis (VL-HLH). Methods: This retrospective study enrolled 21 VL patients categorized into three groups: visceral leishmaniasis only (VL-only, n=7), VL-HLH (n=8), and a clinically indeterminate Grey Zone group (n=6). Clinical and laboratory parameters were compared across groups. For 9 patients with PET/CT, metabolic patterns and correlations between splenic SUVmax and serological markers were analyzed. A simple risk score was constructed based on significant indicators and evaluated across groups. Results: No differences were observed in age, sex, and main symptoms among the three groups. Compared to the VL-only group, the VL-HLH group exhibited significantly higher levels of the inflammatory marker C-reactive protein and greater spleen thickness (P<0.05). Correlation analysis revealed a multi-indicator interaction network centered on "inflammation-coagulation-tissue injury." PET/CT identified the spleen (9/9, 100%) and bone marrow (7/9, 77.8%) as the primary metabolic target organs; splenic SUVmax showed strong positive correlations with D-dimer (r=0.82, p<0.01) and ferritin (r=0.69, p<0.05). The simple risk stratification tool (0-2 points) based on C-reactive protein and spleen thickness demonstrated a clear discriminative trend: the VL-only group concentrated at 0 points (85.7%), while the VL-HLH group distributed across 1-2 points. The Jonckheere-Terpstra test for trend confirmed a statistically significant increasing trend in scores with greater disease severity (from VL-only, to Grey Zone, to VL-HLH) (P = 0.002). Conclusion: This study reveals a systemic "inflammation-coagulation-tissue injury" network in VL, with the spleen as its core metabolic targets. The proposed simple stratification tool based on C-reactive protein and spleen thickness serves as a practical instrument for clinical risk warning.
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